Nonopioid drugs for pain

AN ACT Relating to nonopioid drugs for the treatment of pain; 1
amending RCW 48.43.400; adding a new section to chapter 41.05 RCW; 2
adding a new section to chapter 48.43 RCW; adding a new section to 3
chapter 74.09 RCW; and adding a new section to chapter 43.70 RCW.4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
NEW SECTION. Sec. 1. A new section is added to chapter 41.05 6
RCW to read as follows: 7
(1) A health plan offered to employees and their covered 8
dependents under this chapter issued or renewed on or after January 9
1, 2027, may not maintain prescription drug practices that 10
disadvantage or discourage nonopioid drugs for the treatment or 11
management of pain with respect to coverage relative to any opioid or 12
narcotic drug for the treatment or management of pain, including:13
(a) Designating a nonopioid drug as a nonpreferred drug if any 14
opioid or narcotic drug is designated as a preferred drug; or15
(b) Establishing more restrictive or more extensive prescription 16
drug utilization management practices, including prior authorization 17
or step therapy requirements, for a nonopioid drug that are more 18
restrictive or more extensive than the least restrictive or extensive 19
prescription drug utilization management practice applicable to an 20
opioid or narcotic drug. 21
S-3534.1
SENATE BILL 5916
State of Washington 69th Legislature 2026 Regular Session
By Senators Harris, Chapman, and Saldaña
Prefiled 12/17/25. Read first time 01/12/26. Referred to Committee
on Health & Long-Term Care.
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(2) For the purposes of this section: 1
(a) "Nonopioid drug" means a drug or biological product that is 2
indicated to produce analgesia without acting on the body's opioid 3
receptors and that has been approved by the United States food and 4
drug administration. 5
(b) "Prescription drug utilization management" has the same 6
meaning as in RCW 48.43.400. 7
(c) "Prior authorization" has the same meaning as in RCW 8
48.43.400. 9
(d) "Step therapy protocol" has the same meaning as in RCW 10
48.43.400. 11
NEW SECTION. Sec. 2. A new section is added to chapter 48.43 12
RCW to read as follows: 13
(1) A health plan issued or renewed on or after January 1, 2027, 14
may not maintain prescription drug practices that disadvantage or 15
discourage nonopioid drugs for the treatment or management of pain 16
with respect to coverage relative to any opioid or narcotic drug for 17
the treatment or management of pain, including: 18
(a) Designating a nonopioid drug as a nonpreferred drug if any 19
opioid or narcotic drug is designated as a preferred drug; or20
(b) Establishing more restrictive or more extensive prescription 21
drug utilization management practices, including prior authorization 22
or step therapy requirements, for a nonopioid drug that are more 23
restrictive or more extensive than the least restrictive or extensive 24
prescription drug utilization management practice applicable to an 25
opioid or narcotic drug. 26
(2) For the purposes of this section, "nonopioid drug" means a 27
drug or biological product that is indicated to produce analgesia 28
without acting on the body's opioid receptors and that has been 29
approved by the United States food and drug administration.30
NEW SECTION. Sec. 3. A new section is added to chapter 74.09 31
RCW to read as follows: 32
(1) Beginning January 1, 2027, a managed care organization may 33
not maintain prescription drug practices that disadvantage or 34
discourage nonopioid drugs for the treatment or management of pain 35
with respect to coverage relative to any opioid or narcotic drug for 36
the treatment or management of pain, including: 37
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(a) Designating a nonopioid drug as a nonpreferred drug if any 1
opioid or narcotic drug is designated as a preferred drug; or2
(b) Establishing more restrictive or more extensive prescription 3
drug utilization management practices, including prior authorization 4
or step therapy protocol requirements, for a nonopioid drug that are 5
more restrictive or more extensive than the least restrictive or 6
extensive prescription drug utilization management practice 7
applicable to an opioid or narcotic drug. 8
(2) The authority shall assure that any prescription drug 9
practices that it applies to fee-for-service programs and managed 10
care organizations under this chapter comply with the requirements of 11
subsection (1) of this section. 12
(3) For the purposes of this section: 13
(a) "Nonopioid drug" means a drug or biological product that is 14
indicated to produce analgesia without acting on the body's opioid 15
receptors and that has been approved by the United States food and 16
drug administration. 17
(b) "Prescription drug utilization management" has the same 18
meaning as in RCW 48.43.400. 19
(c) "Prior authorization" has the same meaning as in RCW 20
48.43.400. 21
(d) "Step therapy protocol" has the same meaning as in RCW 22
48.43.400. 23
NEW SECTION. Sec. 4. A new section is added to chapter 43.70 24
RCW to read as follows: 25
By January 1, 2027, the department shall develop and publish on 26
its website an educational pamphlet regarding the use of nonopioid 27
alternatives for the treatment of pain. At a minimum, the pamphlet 28
must include: 29
(1) Information on available nonopioid alternatives for the 30
treatment of pain, including nonopioid medicinal drugs or drug 31
products and nonpharmacological therapies; and 32
(2) The advantages and disadvantages of the use of nonopioid 33
alternatives. 34
Sec. 5. RCW 48.43.400 and 2019 c 171 s 1 are each amended to 35
read as follows: 36
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The definitions in this section apply throughout this section and 1
RCW 48.43.410 ((and)), 48.43.420, and section 2 of this act unless 2
the context clearly requires otherwise. 3
(1) "Clinical practice guidelines" means a systemically developed 4
statement to assist decision making by health care providers and 5
patients about appropriate health care for specific clinical 6
circumstances and conditions. 7
(2) "Clinical review criteria" means the written screening 8
procedures, decision rules, medical protocols, and clinical practice 9
guidelines used by a health carrier or prescription drug utilization 10
management entity as an element in the evaluation of medical 11
necessity and appropriateness of requested prescription drugs under a 12
health plan. 13
(3) "Emergency fill" means a limited dispensed amount of 14
medication that allows time for the processing of prescription drug 15
utilization management. 16
(4) "Medically appropriate" means prescription drugs that under 17
the applicable standard of care are appropriate: (a) To improve or 18
preserve health, life, or function; (b) to slow the deterioration of 19
health, life, or function; or (c) for the early screening, 20
prevention, evaluation, diagnosis, or treatment of a disease, 21
condition, illness, or injury. 22
(5) "Prescription drug utilization management" means a set of 23
formal techniques used by a health carrier or prescription drug 24
utilization management entity, that are designed to monitor the use 25
of or evaluate the medical necessity, appropriateness, efficacy, or 26
efficiency of prescription drugs including, but not limited to, prior 27
authorization and step therapy protocols. 28
(6) "Prescription drug utilization management entity" means an 29
entity affiliated with, under contract with, or acting on behalf of a 30
health carrier to perform prescription drug utilization management.31
(7) "Prior authorization" means a mandatory process that a 32
carrier or prescription drug utilization management entity requires a 33
provider or facility to follow to determine if a service is a benefit 34
and meets the requirements for medical necessity, clinical 35
appropriateness, level of care, or effectiveness in relation to the 36
applicable plan. 37
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(8) "Step therapy protocol" means a protocol or program that 1
establishes the specific sequence in which prescription drugs for a 2
specified medical condition will be covered by a health carrier.3
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